the woman in the picture behind me.

照片裡的那個女人。

Her name is Hosepha.

她叫荷賽法。

And she was born in Cuba

她是古巴人，

several years before the communist revolution.

在古巴革命前幾年出生。

The late 1970's,

1970年代末，

she would then decide to leave

她毅然決然

everything she knew behind,

離開她熟悉的地方，

determined to give her family a chance

為了給家人一個機會，

at a better life in the US.

一個能在美國好好生活的機會。

She also happens to be my grandmother

正好她就是我的祖母，

and one of the most important figures

在我成長過程中

in my life as I was growing up.

對我最重要的人之一。

Some of my happiest childhood memories

童年記憶裡最快樂的部分，

were simply getting to come home,

就僅僅是每天放學後，

every day from school, to be given

回到家裡，

a huge big hug from my grandmother.

祖母給我的一個大擁抱。

But that hug would one day turn my life upside down.

但這擁抱將讓我的生命風雲變色。

You see, as my head brushed up against a side of hers,

你想，當我的頭 碰觸到她一邊的乳房時，

I felt a big lump.

我碰到一個大硬塊。

When I asked her what it was

當我問她那是甚麼時，

she said it was nothing,

她說沒事。

but I would later go on to overhear my family

但沒過多久我就從家人那裏偷聽到，

talking about a tumor and cancer.

他們在談論腫瘤和癌症。

I can't begin to describe to you

我無法向你們形容

what I felt in that moment.

那一刻我的感受。

My grandmother was my whole world

祖母就是我的全部。

and as I stood in that doorway listening

當我站在走廊偷聽時，

I was paralyzed with fear.

我被嚇得無法動彈，

I begged and pleaded with my grandmother

我拜託她、請求她

that she'd go to the doctor,

一定要去看醫生，

but the harsh reality was that

但殘酷的現實是，

my family simply couldn't afford it.

我家根本無法負擔醫療費。

And in my young mind

在我幼小的心靈裡，

the concept of my grandmother's life

我無法接受把祖母的生命

hanging in the balance over a question of money

與金錢放在同一個天平上衡量，

didn't make any sense to me.

這對我來說根本是荒謬至極。

It was perhaps the first time in my life

這大概是我人生中，

I had ever felt powerless.

第一次感到很無助。

Powerless over my circumstances,

為在這種情況下，

powerless at my inability to do anything

無法替對我如此重要的人做任何事

for someone that meant so much.

而感到無能為力。

And I remember desperately wanting a way out.

我拚命地想找到一條生路。

Sometime later, that way out would come

不久之後，這條路出現了。

thanks to the chanced generosity of a family friend,

多虧一位家族世交的慷慨協助，

to whom I'll forever be thankful

我永遠對他感激不盡。

for what he did for my grandmother.

感謝他為我祖母所做的一切。

But, are we comfortable with that?

但我們就這樣逆來順受嗎?

With the notion that a person's life

一個人的生命取決於財力的多寡，

potentially hinges on the means they have?

這樣的觀念對嗎?

That wealth so directly determines

金錢竟能如此直接地影響

something as basic and fundamental as health?

人最基本應該擁有的健康嗎?

At the time, I never questioned that reality.

當時，我從未質疑過現實。

As a kid, I simply internalized my experience

當我還是小孩的時候，

and became intensely focused on the only thing

我單純憑藉著我的經驗，

I felt I had any control over, my education.

專注在唯一一件我能控制的事上：教育。

It wasn't until many years later,

直到多年後，

upon arriving at Stanford,

我來到了史丹佛大學

and taking a health policy course

修了健康政策課程，

that I would come to feel empowered

我才覺得我終於有能力

to revisit and question that reality.

能夠重新探討那些問題。

For ten weeks I sat in class horrified

這十個星期裡我在教室，

and fascinated by what I learned.

既驚詫又著迷於課堂所學。

Horrified by the scale upon which

驚詫於得知在我們的國家，

I saw my own family's health struggles

還有多少家庭承受著和我們家一樣

writ large across our nation.

有過的掙扎。

But fascinated by the potential of policy

但又著迷於得知

to have such far reaching positive effects

健康政策有多大的潛力，

on the lives of so many people.

能夠給多少人的生命帶來正面幫助。

I began to wonder if the current state

我開始質疑

of health care was truly inevitable,

是否現今的醫護狀態真的是無法改善，

or if a different reality was possible.

或者其實有方法可以解決，

And my search for an answer to this question

為了回答這個問題，

would lead me to work

在過去四年裡

over the last four years in five countries,

我到五個國家做研究，

spanning Europe, Asia and Africa.

從歐洲、亞洲，到非洲。

And today I'd like to take you on that journey

今天，我想帶大家

to three of those places.

到其中的三個國家看看。

First on my list was France,

第一個地方就是法國，

which I had learned had been ranked as having

據我所知，

the best health care system in the world,

世界衛生組織於2000年

by the World Health Organization in 2000.

將法國的醫護體制排名世界第一。

And what struck me the most,

在巴黎的醫院工作時，

working in a Parisian hospital, was not

令我最感到驚訝的

only how accessible health care was for everyone,

不只是所有人都能得到的醫護資源，

but how universally agreed upon it was

而是法國人普遍地

among the French that it should be.

把這種情況視為理所當然。

This is something that I would later go on to know

之後，當我在日本工作的一年裡，

about the Japanese health care system,

我又在日本的醫療體制裡

while I was living and working in Japan for one year.

見識到相同的情形。

Here was a country with some

這是個全世界

of the world's best health outcomes,

擁有最佳醫療衛生成果的國家，

longest life expectancy,

擁有最長的壽命，

one of the lowest rates of infant mortality,

最低的嬰兒死亡率。

had managed to achieve universal coverage

當日本還在為二戰重建時，

at a time when Japan was still rebuilding itself,

日本人已經設法讓醫療健康資源

after World War II.

廣布全國。

And yet manages to spend half of what

並且只花費了美國每人

the Unites States spends on health per capita.

花費在醫療健康上的一半經費。

As I reflect on these experiences with you,

我告訴你們這些經驗，

I don't mean to oversimplify the issue

並不是要過度簡化這個議題，

or lead you to believe that I think that

或只引導你們相信，

what has worked in one country is

一個國家實行的政策

directly adaptable or transferable to another.

能夠直接複製到另一個國家。

The more countries and systems

當我有機會

I've had the opportunity to study

研究更多國家的醫療健康體制，

the more I've come to appreciate just how

我就越能領悟到

truly complex the issue of health care is.

這個議題的複雜程度。

But I've also come to believe that

但我還是相信，

what's possible in terms of health care access

健全醫療體制的能否順利推行

is largely dependent on what societies choose to value

取決於社會是否重視這件事，

and make possible for their populations.

並願意使其推行。

The best example I can think of this is Rwanda,

我所能想到最好的例子就是盧安達。

where I recently worked with

最近，我跟柯林頓健康倡議組織

the Clinton Health Access Initiative.

一起在盧安達工作。

A country ravaged by genocide

盧安達在近二十年內

less than 20 years ago.

才遭受種族屠殺的迫害。

10% of its population murdered,

百分之十的人民被殺害，

with more than half of its population

而半數以上的人

still living in poverty.

仍過著貧苦的日子。

The house I lived in didn't have running water

我在盧安達時的居所沒有自來水，

or direct access to paved roads.

戶外的街道也是坑窪難行。

I was fortunate to have electricity,

幸運的是，我的居所有電可以使用，

the only house in the district to have it.

那是在那個地區裡唯一供電的住所。

And yet, even in the absence of

盧安達即使資源缺乏，

so many resources and basic necessities,

連基本的生活必需品都難以獲得，

they felt it was so indispensable

他們仍然深刻地了解，

that everyone should have a basic

每位公民都必須享有 是最基本程度的醫療保障

minimum level of health care

是何等的重要，

that they chose to make it possible.

並選擇付諸實行。

Now I'm not saying that I think that

我並不是說

Rwanda's health care system is perfect.

盧安達的健康醫療體制很完善，

Much work still remains to be done.

他們的體制仍然有許多改進的空間。

But considering that they have

但是每當想到，在盧安達

an annual health budget of $56 per person

每個人每年都有56元美金的醫療預算，

I'd say they are doing pretty well.

我就不得不說他們 的確有套很好的醫療體制。

And the world is taking notice.

世界各國也都開始注意到這件事了。

Something that seemed so impossible

不過短短幾年，

just a few years ago,

發展中國家能夠提供其人民

the notion that developing nations

醫療保障，

could achieve universal coverage,

這件曾經聽起來是如此難以置信的事，

is now not only increasingly being regarded as feasible,

在現今不只越來越多人相信它的可行性，

but as the next step in continuing

甚至已經有人開始思考

to make sustainable global health progress.

如何讓全球的醫療系統持續進步。

That perhaps has been the biggest

這對我來說，

take home lesson for me.

也許是最大的難題。

Where there's a will there's a way!

但，有志者事竟成。

In the US, this doesn't seem to be a question of resources.

在美國，資源從來不是個問題。

According to the World Health Organization's

世界衛生組織

2010 World Health Report,

2010年世界衛生報告指出，

the United States spends over

美國每年在健康醫療上的支出達兩兆，

2 trillion dollars a year on health care,

而全球醫療預算總合 為五兆三千億美元。

out of a global 5.3 trillion.

美國的醫療支出將近佔了全球的40%，

That's approximately 40% of all the money

就僅僅是一個國家花的，

that is spent all over the world on health.

我們的國家。

In one country, in our country.

但不知為何，五千萬的美國人

And yet somehow, 50 million Americans

受害於體制上的漏洞， 無法享有醫療保障。

slip through the cracks, remaining uninsured.

我在盧安達的同事曾說：

In the words of one of my Rwandan colleague, he said,

「萊登，如果連你們都做不到， 那還有誰做的到？」

"Rayden, if your country can't do it, then who can?"

當我從這個方向 去思考醫療體制這議題時，

And when I think about this issue from that perspective,

我發現問題的所在

the question I find myself asking is not

並不是我們是否能夠

whether we can afford to insure a basic

負擔全美所有人口的 基本健康醫療費用，

minimum level of health care for everyone,

而是想不想這麼做。

but whether we choose to make that possible.

去年在北卡羅來納州

Last year, a man in North Carolina robbed a bank,

發生了一起

demanding one dollar, hoping

一元銀行搶案，

to be sent to prison

搶匪希望被關進監獄，

so that he could receive medical attention

這樣他才能夠接受治療，

for a growth in his chest

因為他胸腔長了腫瘤，

he couldn't afford to treat on his own.

而自己無法負擔醫療費用。

How desperate does a human being need to be,

一個人得要多絕望

need to feel,

才會讓他選擇

to be willing to trade his freedom

用自由

for his health?

換取他的健康？

I came to share my story with you today

儘管健康醫療這議題

because despite how divisive the issue

在我們國家意見有多麼兩極，

of health care in our country has become,

但我相信我們仍深切渴望，

I believe that we profoundly want

而且也有資格擁有更好的生活，

and can aspire to more than the status quo,

我也相信我們可以活在財富貧乏

that a world where poverty of wealth

但醫療不貧乏的世界。

does not necessitate the poverty of health is possible.

在這個世界裡， 像我祖母這樣身患重病的人，

A world where people like my grandmother

不用因為資源缺乏 就放棄接受治療。

do not need to forgo potentially life saving treatment

但這卻還僅僅是個理想，

because of a lack of resources.

因為部份立法者、醫生、健康經濟學者，

But this doesn't become possible

還有提倡者，

because a few policy makers, doctors,

過度追求完美的體制。

health economists, advocates get together

真正能夠使我們的 醫療體制從根改造的，

to engineer a perfect solution.

是我們所有人，我們的社會價值

Truly sustainable changes, I believe,

是否重視並相信

are first dependent on what we all,

新健康醫療體制推行可能性。

as a society, choose to value

我們該重視什麼？

and believe to be possible.

我們該如何選擇？

What do we value?

謝謝。

What do we choose?

(掌聲)

Thank you.

(Applause)